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Worldwide Survey of the “Assessing Pain, Both Spontaneous Awakening and Breathing Trials, Choice of Drugs, Delirium Monitoring/Management, Early Exercise/Mobility, and Family Empowerment” (ABCDEF) Bundle

Objectives: To assess the knowledge and use of the Assessment, prevention, and management of pain; spontaneous awakening and breathing trials; Choice of analgesia and sedation; Delirium assessment; Early mobility and exercise; and Family engagement and empowerment (ABCDEF) bundle to implement the Pain, Agitation, Delirium guidelines.

Design: Worldwide online survey.

Setting: Intensive care.

Intervention: A cross-sectional online survey using the Delphi method was administered to intensivists worldwide, to assess the knowledge and use of all aspects of the ABCDEF bundle.

Measurement and Main Results: There were 1,521 respondents from 47 countries, 57% had implemented the ABCDEF bundle, with varying degrees of compliance across continents. Most of the respondents (83%) used a scale to evaluate pain. Spontaneous awakening trials and spontaneous breathing trials are performed in 66% and 67% of the responder ICUs, respectively. Sedation scale was used in 89% of ICUs. Delirium monitoring was implemented in 70% of ICUs, but only 42% used a validated delirium tool. Likewise, early mobilization was “prescribed” by most, but 69% had no mobility team and 79% used no formal mobility scale. Only 36% of the respondents assessed ICU-acquired weakness. Family members were actively involved in 67% of ICUs; however, only 33% used dedicated staff to support families and only 35% reported that their unit was open 24 hr/d for family visits.

Conclusions: The current implementation of the ABCDEF bundle varies across individual components and regions. We identified specific targets for quality improvement and adoption of the ABCDEF bundle. Our data reflect a significant but incomplete shift toward patient- and family-centered ICU care in accordance with the Pain, Agitation, Delirium guidelines.

All authors contributed in study conception; design and critically revised the article; and interpretation of results. Drs. Morandi and Piva have equally contributed as first authors to the article and drafted the article and in acquisition of data.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (http://journals.lww.com/ccmjournal).

Dr. Ely’s institution received funding from Veterans Affairs Geriatric Research Education and Clinical Centers and the National Institutes of Health (NIH) (R01AG035117 and R01HL111111); he received funding from Orion, Abbott, and Pfizer; and he received support for article research from the NIH. Dr. Azoulay’s institution received research grant funding from Fisher & Paykel, Pfizer, Gilead, and Alexion, and he received funding for board member lectures from Alexion, Astellas, and Gilead. Dr. Fan is supported by a New Investigator Award from the Canadian Institutes of Health Research. Dr. Pandharipande’s institution received funding from Hospira Inc in collaboration with the NIH for a research grant. Dr. Pandharipande (R01HL111111 and R01AG035117) and Dr. Needham (R24HL111895 and R24AG054259) are supported by the NIH. Dr. Permpikul disclosed government work. Dr. Shehabi reported related unrestricted research and educational grants from Pfizer and Orion Pharma and the National Health and Medical Research Council of Australia. Speaker’s honorarium and travel expenses reimbursed to employing institution. Dr. Slooter works on the development of an EEG-based delirium monitor, any (future) profits of this technology will be used for future scientific research only, and he is supported by the European Society of Intensive Care Medicine, Technology Foundation STW (14066) and the European Union (H2020-PHC-12-2014-672974). The remaining authors have disclosed that they do not have any potential conflicts of interest.